Under the Paperwork Reduction Act of 1995, n
I6 (07-06)
Approved for use through 1/31/2007. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
id to a collection of information unless it displays a valid OMB cc
PATENT APPLICATION FEE DETERMINATION RECORD
Substitute for Form PTO-875
Application or Docket Number
10/822,641
Filing Date
04/12/2004
□ To be Mailed
APPLICATION AS FILED - PART I
(Column 1) (Column 2)
SMALL ENTITY □
OTHER THAN
SMALL ENTITY
FOR
NUMBER FILED
NUMBER EXTRA
RATE ($)
FEE ($)
RATE ($)
FEE ($)
□
BASIC FEE
(37 CFR 1.16(a), (b),
*<0)
N/A
N/A
N/A
N/A
□
SEARCH FEE
(37CFR1.16(k), (i),
r(m))
N/A
N/A
□
EXAMINATION FEE
(37 CFR 1.16(0), (p), or(q))
N/A
N/A
N/A
N/A
TOTAL CLAIMS
(37 CFR 1.16(1))
minus 20 =
OR
INDEPENDENT CLAIMS
(37 CFR 1.16(h))
□application size fee
(37 CFR1.16(s))
If the specification and drawings exceed 100
sheets of paper, the application size fee due
is $250 ($1 25 for small entity) for each
additional 50 sheets or fraction thereof. See
35 U.S.C. 41 (a)(1)(G) and 37 CFR 1.1 6(s).
□
MULTIPLE DEPENDENT CL
AIM PRESENT (37 CFR 1.16(j))
* If
he difference in col
Iumn2.
TOTAL
TOTAL
APPLICATION AS AMENDED - PART II
(Column 1) (Column 2)
(Column 3)
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
)MENT |
05/14/2009
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
RATE ($)
ADDITIONAL
FEE ($)
RATE ($)
ADDITIONAL
FEE ($)
Total (37 CFR
* 37
- 40
= o
OR
0
LU
* 8
™10
= o
OR
X $220=
0
<
I I Application S
ze Fee (37 CFR 1.16(s))
I I FIRST PRESENTATION OF MULTIPLE DEPENDENT CL^
IM (37 CFR 1.16(J))
OR
TOTAL
ADD'L
FEE
OR
TOTAL
ADD'L
FEE
0
(Colun
n1)
(Column 2)
(Column 3)
I—
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
RATE ($)
ADDITIONAL
FEE ($)
RATE ($)
ADDITIONAL
FEE ($)
LU
Total (37 CFR
OR
DM
Independent
OR
z
LU
I | Application S
ze Fee (37 CFR 1
16(8))
I AM
I I FIRST PRESENTATION OF MULTIPLE DEPENDENT CL/
IM (37 CFR 1.160))
OR
TOTAL
ADD'L
FEE
OR
TOTAL
ADD'L
FEE
* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
" If the "Highest Number Previously Paid For" IN THIS SPACE is less than 20, entei
*" If the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter
The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate
Legal Instrument Examiner:
/ROCHELLE C. GETER/
This collection of information is required by 37 CFR 1.16. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO to
process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This collection is estimated to take 12 minutes to complete, including gathering,
preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount of time you
require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Trademark Office, U.S.
Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.